September 1, 2019

September 2019 Anthem Provider News - Ohio

Administrative

AdministrativeCommercialSeptember 1, 2019

Notice of Material Changes/Amendments to Contract and Prior Authorization Changes -- September 2019
Notice of Material Changes/Amendments to Contract and Changes to Prior Authorization Requirements may apply for new or updated reimbursement policies, medical policies, or prior authorization requirements.

AdministrativeCommercialSeptember 1, 2019

Reminder: Changes to timely filing requirements coming in October

AdministrativeCommercialSeptember 1, 2019

Provider Transparency Update

AdministrativeCommercialSeptember 1, 2019

Anthem launches Sydney on September 1; new app offers better digital health care support to members

AdministrativeCommercialSeptember 1, 2019

Anthem Commercial Risk Adjustment (CRA) Reporting Update: Risk Adjustment Data Validation (RADV) Audit happening now

AdministrativeCommercialSeptember 1, 2019

Claims requiring additional documentation facility reimbursement policy update

AdministrativeCommercialSeptember 1, 2019

PCP after-hours access requirements

Behavioral Health

Behavioral HealthCommercialSeptember 1, 2019

Access requirements for behavioral health care services

Policy Updates

Medical Policy & Clinical GuidelinesCommercialSeptember 1, 2019

Clinical Guideline Updates -- September 2019*

Reimbursement PoliciesCommercialSeptember 1, 2019

New Reimbursement Policies: Maternity Services and Multiple Delivery - Professional*

Reimbursement PoliciesCommercialSeptember 1, 2019

New Reimbursement Policy: Intensity Modulated Radiation Therapy Planning and Delivery - Professional*

Reimbursement PoliciesCommercialSeptember 1, 2019

Claim editing update for Excludes1 notes

Products & Programs

PharmacyCommercialSeptember 1, 2019

Clinical criteria and prior authorization updates for specialty pharmacy are available*

State & Federal

State & FederalMedicare AdvantageSeptember 1, 2019

Medicare News -- September 2019

State & FederalMedicare AdvantageSeptember 1, 2019

Coming soon: Electronic attachments

State & FederalMedicare AdvantageSeptember 1, 2019

Clinical Criteria updates

State & FederalMedicare AdvantageSeptember 1, 2019

Customizations to the 23rd edition of the MCG Care Guidelines

State & FederalMedicare AdvantageSeptember 1, 2019

Changes to prior authorization (PA) requirements

State & FederalMedicare AdvantageSeptember 1, 2019

Pharmacy benefit manager change to IngenioRx